Non-smokers have less trouble stopping

The influence of identity on a smoker’s behaviour

Poster depicting the effects of smoking on male fertility, by the organization Action on Smoking and Health (ASH)

By Bart Braun

A month without cigarettes is doable. But whether smokers can really give up the habit depends on their identity, according to a Leiden health psychologist. “It has to become something that suits you.”

(Nederlandstalige en langere versie hier)
There are 3.6 million smokers in the Netherlands and the statistics predict that cigarettes will kill two million of them. And then there are the minor disadvantages of social stigma, breathlessness, curtains that need frequent washing and the fact that you are literally letting your cash to go up in smoke. The question is not whether people should give up smoking, but how.
Health psychologist Eline Meijer, (“I have never smoked”), is studying the identity of those who stop. “Is smoking crucial to something they see in themselves?” she wonders, “Or do they consider themselves non-smokers who just happen to light up? Some people I interviewed literally described themselves like that.”
It certainly makes a difference, explains the PhD student. “The more inclined people are to regard themselves as non-smokers, the more inclined they are to stop.” It applies the other way round too, according to other researchers: people who think that smoking is essential to their identity will have more trouble stopping. “But our study shows that the non-smoker identity has more impact.”
Meijer and her colleagues interviewed 188 smokers, examining the consequences of the smoking ban in cafés has had on them. “Some of them had a stronger urge to stop smoking because of the ban, but another group felt patronised – they saw it as a personal matter that has nothing to do with the government. The ban makes those people feel even more like smokers, making it harder for them to drop the habit.”
Then there’s a third group: “The smoking ban has emphasised how addicted they are; they see themselves as victims of something they can’t change anymore. In those cases too, the smoking ban in cafés is counterproductive and the same seems to apply to the warning messages on cigarette packets: ‘Smoking Kills’ and so on. They motivate some people to stop but just upset others. And when smokers are stressed, they smoke more.”
Wouldn’t it be a better idea to put encouraging texts on the packets? “If you give up cigarettes, your skin will be healthier” or “Stop , and you won’t be out of breath after climbing the stairs”? “That sort of measure has been studied exhaustively, but each time the results are different. From our identity angle, you might suppose encouragement would help. At least, it wouldn’t scare people into smoking”, Meijer replies.
The effects of anti-smoking policies tend to be ambiguous at best. Do anti-smoking campaigns help? Do warning pictures on packets help? Does warning smokers about the risk of impotence have more effect than warning them about mouth cancer? Would it help if we banned displays of tobacco products from shops? Even when the studies were conducted properly – which is far from always the case – it was impossible to assess the results of the policy measures individually as nations usually introduce several anti-smoking measures at once.
However, things are clearer for smokers who want to give up smoking. Meijer outlines what they should do: “Make a plan: smoking is an addiction you can’t just drop. Fix a date and work towards it. Plan in advance how you intend to deal with difficult situations like parties. It’s very difficult to stop on your own so look for help. Your GP can give you a hand if you want to give up smoking.”
The nicotine vaccine hailed as a promising solution a few years ago doesn’t work. Nicotine replacement gum and patches help but aren’t covered by insurance any more. If you have a history of failed attempts, your GP might prescribe Champix, now a proven remedy. E-cigarettes as aides to stopping smoking are still being hotly debated.
And what about identity? “Not smoking has to become something that suits you”, Meijer says, summarising her research results. “But I don’t know the best way to achieve it. At Alcoholics Anonymous, drinkers have to explain what got them drinking in the first place and why it suits them not to drink. They have to repeat it frequently so they really feel a change. Another idea is to encourage people to form a mental image – even paint one perhaps – of themselves as a non-smoker. Or ask them to list the similarities between themselves and non-smokers to reduce the distance between them.”
Meijer adds: “The big question is how to make people amenable to it, how to persuade them to think about stopping. During the interviews, I noticed that a shock can help some people – at least, in the short term. I talked to someone who had lost a friend to lung cancer just days before I spoke to him. He had already stopped – for a few days, that is. For long-term success, it’s more important that people believe they can do it.”

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